<block name="style">
    <style type="text/css">
         .ajax-form{ overflow: hidden;}
         .ajax-form .form-div{ overflow: hidden; margin-bottom: 10px;}
         .ajax-form .form-div .left{ text-align: right;}
         .is_confirm_text{ font-size: 18px; text-align: center;}
         .is_confirm_box input{ width: 50%; float: left;}
    </style>
</block>
<!-- 模态框HTML -->
<form class="ajax-form" method="post" action="{:U('shop/distribution_profit',array('action'=>'withdraw'))}">
	<input type="hidden" class="form-control" name="id" value="{$id}" />
    <div class="form-div">
        <div class="col-md-3 left">粉丝ID：</div>
        <div class="col-md-8">{$mid}</div>
    </div>
    <div class="form-div">
        <div class="col-md-3 left">提现金额(分)：</div>
        <div class="col-md-8"><input type="text" class="form-control" name="price"></div>
    </div>
    <div class="form-div">
        <div class="col-md-3 left"></div>
        <div class="col-md-8">
            <input type="submit" data-role="submitreport" value="确认提现" class="btn btn-primary send_box">
            <input type="button" value="取消" class="btn send_box" data-dismiss="modal">
        </div>
    </div>
    
</form>
